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Season 1 Highlights and A Sneak Peek at Season 2
[1:13] There are a lot of “aha” moments when a patient understands that they feel a certain way not because of a character flaw or weakness, but because of a genetic variance or vulnerability. The more they are on board with the process, the more the patient can strengthen their twin engines of change, self-motivation (I want to change), and self-efficacy (I believe I can change), When a patient believes getting better is possible they are truly empowered.
[3:18] When a patient starts supporting their genetics, they can have more dopamine and serotonin bio-availability, making it easier to take action on the things that really matter for their health.
[4:33] To recap Episodes 1-7, we covered over 22 SNP’s and how they relate to the common top objectives of our patients: mood, immune resilience, weight-management, and exercise.
[5:18] In Episode 1, we introduce ourselves and the concept of using a 30-minute Nutritional Genomics consult to meet the patient, build rapport, and trust, and create validity to order more diagnostic labs to investigate further the phenotypic expression of their genome to better understand why are they reacting to their environment or tipping into unhealthy coping strategies.
Episode 2, Dr. James Greenblatt, a pioneer in the field of integrative medicine, joins us to discuss MTHFR and COMT genetic influence on neurotransmitters, and how it may influence our behaviors.
Episode 3, Dr. Sam Yanuck discusses with us ways that genetic testing can give us insight into chronic inflammation.
[6:18] Episode 5 is the first of a two-part series where we explore how environmental and emotional factors such as stress and fear have an impact on our eating patterns. We welcome Morgan Knull who talks about how she customizes eating plans for her clients through her company Feed your Genes.
Episode 6, we dive into the common saying “eat right and exercise” and how that’s not a one size fits all approach to health and a healthy weight. Dr. Penny Kendall-Reed joins us to talk about mood and food, and take a further look at a few key metabolic hormones that drive appetite and satiety.
[7:09] Episode 7 continues the “eat right and exercise” conversation by looking at how our genetics can help make sense of what exercise is right for us, the risks to be extra careful of, and the timing of when to include exercise into a personalized, therapeutic plan.
[8:52] We like to approach nutritional genomics with the idea that it isn’t everything or a magic pill, but a powerful tool.
[9:48] In Episode 4, a business application episode, we covered the four models of pricing and gave the pros and cons, starting from the insurance model and working our way into transitioning to the cash model. Just like working with clients in functional medicine, the name of the game here is starting slow and building on success.
[12:07] The recommendation of having nutritional genomics as a 30-minute entry point to your practice is to build trust and rapport with your patients, and not to overwhelm them with so many diet, lifestyle, and medical recommendations that they feel overwhelmed and never come back.
[15:52] In Season 2, we will extend and expand the conversation of creating an entry point for prospective clients beyond the complex patient. We will talk about setting up welcome calls, integrating health coaches, functional finances, and share a program we are designing to attract a new audience to functional medicine in 2021,
[24:47] Good Medicine On the Go is our real-time series where we evolve Dr. Nathan Morris’s dynamic practice openly for all to see, so you will see the trial and errors and can follow along if you too would like to create a new entry point to service the masses right when they need Functional Medicine the most.
Kara Ware: (00:09)
When we first launched Episode 1 in April, we were all sheltering in place. And in that very first episode, we talked about how relevant nutritional genomics is because of the epigenetic effects of our environment and our gene expression, and we discussed using nutritional genomics as an affordable entry point that may be less intimidating than the traditional to our new patient appointment to attract new patients or reactivate former patients. Because ultimately, of course, the goal of ours is to create a deeper long-term commitment to the functional medicine process, and nutritional genomics as an entry point already allows us to use data that the patient already has purchased and, therefore, they are beginning the functional medicine journey with maybe a smaller investment upfront.
Dr. Nathan Morris: (01:02)
Yeah. That’s really important, Kara, what you meant as far as the smaller investment, and I think that’s all a big problem is the entry point for a lot of patients is so large. And so maybe just a half-hour of nutritional genomics or an hour is really important for attracting that new patient. And the other thing that I see is the empowerment that we see with genomics. A lot of times, there’s a lot of aha moments when the patient understands why you’re going to make the recommendations you’re going to make or order the labs that you’re going to order, and all of a sudden that patient feels part of the process. They feel like they have an understanding and that they now understand why their body may be reacting in the ways that it’s doing. And if you can empower a patient, you really put in place those twin engines of change, self-motivation, and self-efficacy, and I really think your story in Episode 2 was really enlightening there. Could you share that with us?
Kara Ware: (01:56)
Yeah. I’m going to repeat that: Twin engines of change, because the self-motivation… A lot of us want to change, but then the self-efficacy is actually feeling like we can. And in Episode 2, I briefly shared a personal story just about how traumatic trauma, stress, and my genes interacting really set me up for some scary suicidal tendencies and understanding that these were just vulnerabilities that under severe stress and trauma, of course, I was going to tip into unhealthy coping strategies. And that’s really empowering to understand this isn’t a character flaw. This isn’t a weakness. And hey, I can just understand where I may need higher demands of nutrients where my body’s drawing those nutrients and I need a higher dose to support my function and health and then ultimately vitality. In the 14 years that I’ve been involved in functional medicine, one of the most empowering things is to understand my genetic vulnerability.
Dr. Nathan Morris: (02:57)
That’s such a powerful story and so brave of you to tell, Kara. I can’t tell you how happy I am that you shared that because it was just really powerful. So thank you for talking about that again, but I think it really emphasizes that point of empowerment to change and I think that’s really important.
Kara Ware: (03:10)
When we start supporting what we’re going to talk about here in a minute to recap Season 1, when we start supporting our genetics, then we feel like hey, we can do this because we have some more dopamine and serotonin bioavailability, for example. I mean, it’s incredible. It really is amazing.
Dr. Nathan Morris: (03:28)
And the other thing that we see with what we’re talking about besides attracting and empowering is validation to order more diagnostic testing, and I mentioned that a little bit earlier. But as we see these genetic vulnerabilities and we can check and see if that’s really presenting in the patient. And once we do that and we can get those labs and we can say, “Okay, yeah, we’re definitely seeing these things” and meeting patients where they’re at, we can then convert that patient into a longer-term patient so we can see them for the genomics and then we can say, “Okay, to explore this more we really need to connect that phenotype which is how you present what your labs are, what your history is. We need to connect that phenotype to the genotype”, and that’s a great segue into saying, “Maybe we need a longer appointment than just this. Would you like to explore this further?” So I really like that aspect of [inaudible 00:04:17], too, which will bring us to some caveats we’ll discuss a little bit later.
Kara Ware: (04:21)
Yeah. Everything we’re doing in our industry is spot on. It’s just breaking it down in more incremental steps so that it feels less intimidating. All right. This is Episode 8, the last episode in our very first season and we have already started working on Season 2, so we’re going to be back in a few months. But today let’s go over where have we been. So to recap, the eight episodes we covered over, I think, 21 or 22 snips. I mean, it was quite a good batch to begin if you’re new to nutritional genomics as a practitioner just to begin to familiarize yourself because these snips do serve as an effective entry point to understanding and then applying nutritional genomics to address the patient’s top objectives. And as you said earlier, Nathan, mood and immune resilience and always weight management and exercise, no matter what the current events are happening.
Kara Ware: (05:17)
So in our first segment with Dr. James Greenblatt when we were discussing mental health, he’s a duly board-certified psychiatrist. We’re so fortunate to have him in our industry helping us understand how to support patients, and he discussed the genetic influence on neurotransmitters and their receptors. Patients with risk variants in this health category may experience behaviors related to dopamine or serotonin and balance and the way MTHFR and COMT also influenced those.
Dr. Nathan Morris: (05:47)
And then we talked about immune, which I think is very relevant, of course, right now, Kara. And Dr. Sam [Yanuck 00:05:52] guided us on functional immunology and how balance is essential, which I think a lot of people always worry about too much inflammation, but too little and our bodies are in trouble, too, so it’s a double-edged sword. Immunology always is. It’s always finding that balance, that Goldilocks of immunology as I call it, and genetic risk variance can influence how we get to that Goldilocks space where our bodies respond to high and low levels of inflammation appropriately. And a lot of information is available in the genetic report that tells us kind of how each patient is going to respond to different insults.
Kara Ware: (06:27)
We tackled why eat right is bad advice, and we met with Morgan Kendall and Dr. Penny Kendall-Reed, and they taught us the connection between mood and food. I love that conversation. Morgan explains that dopamine and serotonin drive food-seeking behavior and can be the underlying cause of patients presenting with weight management issues, and then Penny connects the dots by showing how neurotransmitters influence key metabolic hormones, the leptin, and ghrelin that we discussed which drive our appetite and satiety. And understanding these risk variants that influence mood and food is important when helping patients with one of the most common concerns, weight management.
Dr. Nathan Morris: (07:07)
Yeah. And then right behind that, we always hear the term eat right and exercise, of course. So right after those episodes, we talked about exercise, which was one of my favorite episodes because I learned so much. And we really explored what we can find in the genetic report that can give some clues as to how a patient should exercise, duration times intensity is really determined by Il-6, and how we should possibly be telling patients to exercise. And also we kind of explored, which I think is an important point, when should they exercise, and we really need to apply our functional medicine training to understand that when is really important and right away is not always the best thing.
Dr. Nathan Morris: (07:49)
And then I just wanted to add a quick caveat. Of course, once I get into something I can’t quit reading, and so I was reading some more about Aisle 6 and it was interesting. Magnesium is a big player in Aisle 6 response and exercise, and the lack of magnesium can lead to more inflammation. So favorite mineral in the whole world, magnesium, and as we go forward, but just to give you a little new nugget of information there.
Kara Ware: (08:12)
Again, that just shows we’re always learning, right, and then applying. And so, of course, there are so many more snips that are important for each of these categories, and we’re going to continue to unpack how to apply a nutritional genomics report. And remember, you can always listen to past episodes and learn more because we’ve been creating gene charts and blog posts and transcripts, and all of this is available at karawarecoaching.com/podcast.
Dr. Nathan Morris: (08:38)
So Kara, before we leave nutrigenomics, I think there are some caveats I wanted to explore real quick just to make sure the listener understands that nutrigenomics, we explored it a lot in Season 1. It’s part of a more comprehensive functional medicine approach, and I’ve actually sat in on some consults. My friends have asked me to be on them with other platforms and it’s like genetics is everything, you don’t have to really look at the patient, and I think that’s really not how we want to approach nutrigenomics. We really want to approach it as a tool in the tool bag. It’s not Thor’s magic hammer. It’s a hammer that’s in your toolbox with screwdrivers and wrenches and everything else.
Dr. Nathan Morris: (09:13)
Then the other thing that I hope I got across in Season 1 is that genes are not good or bad. It just depends on your environment and where you’re at just like MTHFR. Actually having that polymorphism decreases your chance of getting malaria. So at some point in history, it served a purpose, but when we’re not really struggling with malaria and we’re not eating a lot of green leafies and having a lot of folate in our diet, then it’s not going to be good and great problems with mood and that can create problems with cardiovascular issues.
Dr. Nathan Morris: (09:41)
So there’s my two caveats that I really wanted to bring up before we left the subject and moved on to another topic we talked about and we had a really good discussion is about: The pricing model. This was really important to understand that a lot of our new practitioners, you really can’t look at the industry standard and just start there. You really have to build that reputation and work your way up, and that’s okay. Then once you build that client base and raise prices, we looked at starting out in the insurance model if that’s where you’re at and how do you transition into a cash model if that’s where you want to go. So that was another one of my favorite episodes
Kara Ware: (10:16)
Yeah, and that’s following our philosophy, right, of starting slow, building on success, breaking this whole process down in incremental steps.
Dr. Nathan Morris: (10:24)
Yeah, Kara. It took me a lot of years to figure this out. When I went into functional medicine, I’d get really excited. I’d see a patient. I’d create this what I thought was a brilliant plan. Here you go. You’re going to do this and you’re going to do this and you’re going to do this, and the lack of simplicity really took this amazing enthusiasm that I was seeing in my patients. They were ready to get better and I was picking up on that enthusiasm, and then I gave them this impossible list of things to do. And I think that’s kind of what I wanted to get across in this first season was that we really want to explore simplicity and how do we create steps for patients to get better, and that’s really about creating endurance for the long journey. Toward the end of my practice in Ohio, it would take four or five visits to really institute my complete plan, and I saw so much more success and people were coming back one, two, three years later with continuing success, saw me last because I was able to break it down. And I think we kind of focused a lot in Season 1.
Dr. Nathan Morris: (11:30)
It kind of organically evolved into how we discuss nutritional genomics because that’s really one of the first steps that I kind of create this leverage point with patients. And it’s just a really affordable incredible starting point and functional medicine which allows you to build trust and rapport with the patient and help them understand why you’re doing some of the things you’re doing. So that was one of the entry points I used. I liked using that. [inaudible 00:11:55] your first visit is just to discuss your genomics and then introduce them into functional medicine more.
Dr. Nathan Morris: (12:01)
So that’s really where we’ve kind of explored, and we’ll talk about that more, kind of review some of those things we looked at Season 1 and how pure genomics, which is a platform I have co-created, is a great clinical decision-making tool to help meet patients’ top objectives. And the ones we talked about really are how providers can step in without being overwhelmed with genomics. Things like mood. Most people have issues with mood. If you’ve been in medicine, you know this. Immune resilience, which is really relevant to the times we’re in right now, and then exercise and weight management I think most everybody is wanting to be doing better at that, Kara.
Dr. Nathan Morris: (12:41)
So this is really where the rubber hits the road for patients. They’re seeking this information, and you help them make those decisions based on genomics. But that’s not all that this podcast is going to be about, of course, and so that’s what we’re going to talk about in Season 2 is how do we take some of these tools and explore more and then really create this simplicity, this journey that a patient can go down and not feel overwhelmed, which is a common problem in functional medicine.
Kara Ware: (13:11)
So Season 1 was an entry point for practitioners new to nutritional genomics, and Season 2 is going to be about creating entry points for patients who are new to functional medicine. And how do we set up our welcome call and how do we talk to patients to make sure that they’re a good fit and about the importance of a health code which is going to be one of my favorite topics to talk about. And of course, with the goal in mind of helping create you, the listener, an approachable, affordable, a sustainable functional medicine practice. So we’re going to talk more right after this.
Speaker 1: (13:47)
This podcast is sponsored by the Atrium Innovations family of professional brands offering evidence-based supplements, advancing scientific research, and providing clinical protocols and technology to empower practitioners globally. Our brands include Pure Encapsulations, number one trusted and recommended brand by practitioners, Douglas Laboratories, Genestra Brands, and LivingMatrix, the fastest-growing digital patient management system for functional medicine.
Kara Ware: (14:19)
With all that’s going on and the epidemic of so many lifestyle diseases, the masses need more affordable and approachable lifestyle medicine. At the same time, many practitioners are struggling with burnout and financing an alternative model of medicine in private practice. So in Season 2, we’re going to share our approach to solving both of these problems and we’re going to focus on how do we bring functional medicine to the masses by making it more approachable, affordable, and sustainable to both patient and provider.
Dr. Nathan Morris: (14:52)
We need to kind of understand how we got here under, understand the past to better inform our future, right, Kara? We talk about that and what’s currently happening in our industry that needs to be re-imagined, and I think I’m a great example. As soon as I entered functional medicine, I kind of felt like I had to be an expert right away and God, that was so much pressure and I felt it, and it really created a lot of stress all the time because I felt like I needed to be the expert. Then a lot of complex patients started showing up. I always say the problem is you get to Level 1 and you’re like, “Oh, I got to Level 1”, but then the next round of patients come because you did well at Level 1. You moved to Level 2, and before you know it you’re like the upper levels and you’re seeing every patient is complex.
Dr. Nathan Morris: (15:37)
And then you get the really straightforward patient, the patient that just wants to be proactive or the patient that has just one problem, and you’re realizing, “Hey, I’ve set this whole practice up for really complex patients. What is available to that patient that wants to enter in at a level that right now I’m charging a complex patient level at because I’m having to spend two-and-a-half or three hours in that first visit. What do I do for that patient? Can I help my practice not be so complex all the time?” I like complex patients, but man, if that’s all you do, you get a lot of burnout. And so if I could have some of these fun patients where we’re just talking about, “Hey, how do I exercise or how should I eat, and I just want to be proactive and not get what my parents had.”
Dr. Nathan Morris: (16:20)
That should be something different, and so that’s where I’m really excited about what you’ve imagined. Actually, it was kind of your genius that came up with this idea so I have to give you credit, but it really will improve patient retention if we can reimagine that entry point program and be able to make sure that we’re not excluding that patient that is 80 to 90% of the people that want to see functional medicine doctors are excluded because they’re not complex enough. And so we’re really going to take that and make a more available entry point that will help both the physician avoid burnout and being overwhelmed all the time and feeling that pressure and having a diversity of practice as one size really does not fit all.
Kara Ware: (17:02)
Yeah. That’s so well said, Nathan. I love that. It’s not one size that fits all. And right now we do have that complex infrastructure, financial, and time requirement that is designed for complex patients. So now let’s reimagine. Okay, well, how do we open up functional medicine to this new audience and service the masses when they need us the most? And that’s really going to be about Season 2 is re-imagining another entry point in addition to the complex patient.
Dr. Nathan Morris: (17:30)
Kara Ware: (17:30)
Yeah, but just re-imagining how to attract a broader audience. And so since this is our real-time series, we’re going to openly evolve the aerodynamic practice. That’s why I’ve always been so grateful to you, Nathan. You’ve given me tons of creative freedom in your practice to say, “Hey, what about this? I just kind of see this gap and how can we address this?”, and you’re like, “Yeah, go with it.” And so thank you.
Dr. Nathan Morris: (17:52)
The benefit of being friends and partners in something, Kara. [crosstalk 00:17:52]
Kara Ware: (17:52)
Yeah. So thank you. And you’ve always given me so much validity as a health coach, and in our industry, it’s important for us to learn how to effectively use and integrate a health coach in practice so to support the success of both the provider and the patient and then the practice so everyone wins, and that’s your business model, Nathan, which I love. If the patient wins, you win, society wins, then we’re really serving our purpose. And so we’ve always kind of had that as our Northern star whenever we’re creating programs. And what we’re going to do in Season 2 is we’re going to walk you through, or you’re going to have a front-row seat, into how we are designing programs. We’re going to have beta testing a couple of months before we offer this in your practice in 2021, which is going to be a perfect time to offer these programs for this new audience.
Kara Ware: (18:47)
And when we talk about new audience, we’re thinking those proactive patients or maybe someone who is newly diagnosed and they want functional medicine, but not necessarily ready for such a huge financial or emotional investment just yet. Or maybe even those patients who have tried everything and nothing is working, and we can set up a program to really establish a foundation so then ultimately those advanced medical interventions can provide the profound results that we know.
Kara Ware: (19:14)
So we’re going to talk a lot about finances in Season 2, one of my favorite topics, functional finances and how we address the limitations of patients and their financial priorities and their perceived risks, and how we work with them so that they can have functional medicine be a part of their life.
Dr. Nathan Morris: (19:35)
Finances are part of the overwhelming process, right? And if they don’t understand where they’re going and that spending this money now saves them tremendous amounts of money in the future, it’s kind of like that retirement plan thing I always give. If you start putting money into your retirement account at 30, you’re going to do a lot better than if you start at 60. It’s going to take a lot more, and that’s really functional medicine. If we can get that concept across of how finances now and how we make it affordable for them but they can really create a lot of long-term gains, I think that’s really important. And that’s part of preventing new patients from feeling overwhelmed. And when I overwhelmed patients, I found that I did not retain them. And that’s why I had mentioned earlier I learned that it may take three or four visits to get the patient where I want them to have the sleep study, to have the nutrition in place, and to have the lifestyle things in place, and so this is really important. And in order for functional medicine to be successful, we must help patients to convert enthusiasm to endurance for the long journey. I mean, that’s really… And so many people have the enthusiasm and we kind of crush it when we overwhelm them.
Kara Ware: (20:40)
Yes. Yeah. Lack of simplicity. Lack of simplicity inadvertently stifles enthusiasm, and then we can’t make that conversion to endurance for the long term.
Dr. Nathan Morris: (20:48)
And it is a long journey, Kara. And many patients in maintenance plans are a great base for your practice. You really want to have that patient coming back in six months or a year and saying, “Okay, what can we do? What can we remove?” I think that’s important. What can we add if we need to, but just to create that competence and that great doctor-patient relationship? And as a doctor I’ll tell you, I have so much more gratification in my practice if I can follow patients for five or 10 years and watch them grow as an individual and as a patient and their health improve. It’s really rewarding, and it really is one of the ways I think is so important to prevent burnout is to have that long-term relationship.
Kara Ware: (21:28)
Yeah, yeah, yeah. So Season 2 is going to be how are we going to make programs: (a) That’s more approachable for a new audience and affordable, how can we kind of break this long journey up, and this is going to help practitioners, I think, create a successful long-term functional medicine practice that they really have a solid base that like you said of those patients in maintenance, and then also sustainable where they’re with you for several years rather than trying it and then chalking it up like, oh, that was something that didn’t work.
Dr. Nathan Morris: (22:02)
Yeah. It makes you feel like crap as a provider. You see them [crosstalk 00:22:02]
Kara Ware: (22:03)
Yeah. Why didn’t they ever come back? And I think that’s the number one question in our industry: What happened? Why did they never come back?
Dr. Nathan Morris: (22:09)
I can tell you why.
Kara Ware: (22:14)
And that’s what we want to address in Season 2. Yeah, yeah. It was just the investment was too much too soon upfront, but that’s okay. This is easily addressed, and I’m really excited about Season 2. So it’s going to be released in October. We’re working on it now, and we’re going to show the real-time beta testing so you’re going to see all of our trial and errors, so to be prepared to open up these programs in your practice in 2021. So if you want you can follow along and imagine how you can create these for your practice as preparation to offer these programs for the new year. What a perfect time, right? So we need to start now to be ready.
Kara Ware: (22:52)
So thank you so much to our listeners. Of course, as we said in our very first episode, we are all in this together. And so please sign up for updates on Season 2. I’m putting a forum on my website so that you can get updates and remember to rate and review and subscribe and tell a friend because this is exciting as we all work together to reimagine the functional medicine journey.
Kara Ware: (23:15)
In the meantime, we encourage you to listen to Season 1, and if you are ready to add nutritional genomics into your practice, you can schedule a free business integration coaching session with me on the PureGenomics business integration manager. You can go ahead and create your free account at puregenomics.com and we can get started with integrating this tool into your practice.
Dr. Nathan Morris: (23:37)
Kara, I can’t wait. This is going to be an awesome next season.